Belgian (Chinese herb) nephropathy: why?

During the last years several patients with renal failure were admitted in Brussels hospitals. The progressive interstitial fibrosis with tubular atrophy seen in these patients has been ascribed to the slimming therapy preceding the pathology. The nephropathy was remarkable with regard to its extensive fibrotic process and the rapidity of its evolution. The ingestion of Aristolochia fangchi instead of the prescribed Stephania tetrandra, one of the components of the slimming therapy, was put forward as hypothesis for the etiology of the nephropathies in the literature. Questions however remain unanswered: Why have certain persons, among thousands similarly treated including ingestion of Aristolochic acids, not withstood the treatment? Why is there no correlation between the length of treatment and the occurrence nor the degree of illness? Last but not least: Is it in the actual conditions possible to be confident again in slimming treatments as the concerned one? We made an overview of the pharmacological action and possible (nephro) toxicity of the known components of the concerned therapy. Concerning the Chinese plants we have described and commented on the procedures for quality control actually at disposal and the difficulties in differentiation between resembling species and possible substitute herbs. We have described largely the traditional and medicinal use of the involved Chinese plants as to evaluate their implication in the nephrotoxicity. The elements of the therapy possibly relevant in the etiology of the disease are mentioned. The overview shows that different elements of the therapy are hazardous. Attention is caught to the danger of the use of (Chinese) herbs of unknown origin when nor the indications nor the form of preparation--in this case decoctions--are respected and when the quality cannot be assured, due to lack of (official) operating procedures. Medicinal plants as those implied contain secondary metabolites (bis)-benzylisoquinoline-alkaloids, dihydroxy-diallyl-biphenyls, aristolochic acids) with strong pharmacological (and possibly toxic) actions. Attention is caught to the danger of alternative therapies as mesotherapy. Products are injected which are not proved safe for this administration way. The administration during long periods of cocktails with anorectics (fenfluramine and diethylpropion) in association with a diuretic, a tranquilizer, plants with laxative and atropinergic action are alike to be at the origin of susceptibility in the excretion system. Under these circumstances exposure to any toxic product might cause renal failure. Several years have passed after the scientific reports of the first nephropathy cases in Belgium. We are afraid that prohibiting (temporarily) three Chinese herbs (Stephania tetrandra, Aristolochia fangchi and Magnolia officinalis) does not provide enough safety in order to assume responsibilities for common health care. Keeping in mind that these treatments were not meant to cure any disease but only for slimming, we ask Belgian authorities to regulate strictly the use of (Chinese) herbal medicines, the products and practices in alternative practices as mesotherapy and cocktail-treatments.

Valepotriate content in different in vitro cultures of Valerianaceae and characterization of Valeriana officinalis L. callus during a growth period.

Different in vitro cultures of Valerianaceae were analysed for valepotriate content [(iso)valtrate, acevaltrate, didrovaltrate] in a study on properties of production in vitro (plant species, growth conditions, differentiation level, valepotriate content of the medium after growth). The in vitro cultures were: callus cultures of Valeriana officinalis L., Valerianella locusta L. and Centranthus ruber L.DC.; a suspension culture of Valeriana officinalis L. and a root organ culture of Centranthus ruber L.DC. All of the cultures produced valepotriates in vitro in different amounts. None of the media that had served for growth contained any valepotriates. In order to characterize the in vitro growth more precisely different parameters were analysed at different time intervals during a growth period in one of the cultures (callus culture of Valeriana officinalis L.). These different parameters were: fresh and dry weight, lipid and nitrogen content and (iso)valtrate content. This study during a growth period was performed on two media differing in plant hormone content.

Microscopical study of valepotriates in lipid droplets of various tissues from valerian plants.

A microscopical study was performed in order to localize chromogenic valepotriates in roots (in vivo) and in callus and root organ cultures (in vitro) of valerian plants. These in vitro cultures (producing valepotriates) contained lipid droplets having the same aspect as those containing essential oil described in the hypodermis and cortex of valerian roots, although only lower fatty acids were present in steam-distillate extractable fractions. These droplets can be coloured with the lipophylic dye Soudanred III and with HCl/acetic acid reagent, suitable for the detection of valepotriates, in fresh root material as well as in cultures in vitro. The droplets were isolated from a Potter homogenate of root organ cultures and shown to contain valepotriates. The oil vesicles of valerian roots, described before as exclusive containers of essential oil were shown to contain also valepotrites.

High-performance liquid chromatography of benzophenone derivatives for the determination of benzodiazepines in clinical emergencies.

A screening procedure for fifteen 1,4-benzodiazepines in biological material (urine), suitable for clinical toxicology, is described. The benzodiazepines and/or their metabolites are hydrolysed to their benzophenones; after alkalinization, the benzophenones are extracted with chloroform. The extract is evaporated to dryness and the dried residue is dissolved in methanol and analysed by high-performance liquid chromatography on a reversed-phase column at 254 nm with methanol-water (1:1) as eluent.